Provider Demographics
NPI:1508589946
Name:VISHWANATH, MALAVIKA (BA)
Entity Type:Individual
Prefix:
First Name:MALAVIKA
Middle Name:
Last Name:VISHWANATH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11505 ALLECINGIE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4301
Mailing Address - Country:US
Mailing Address - Phone:804-286-2625
Mailing Address - Fax:
Practice Address - Street 1:870 COMMONWEALTH AVE STE R
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1233
Practice Address - Country:US
Practice Address - Phone:617-278-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program